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Tistad, Malin
Publications (9 of 9) Show all publications
Nyberg, A., Tistad, M. & Wadell, K. (2019). Can the COPD web be used to promote self-management in patients with COPD in swedish primary care: a controlled pragmatic pilot trial with 3 month- and 12 month follow-up. Scandinavian Journal of Primary Health Care, 37(1), 69-82
Open this publication in new window or tab >>Can the COPD web be used to promote self-management in patients with COPD in swedish primary care: a controlled pragmatic pilot trial with 3 month- and 12 month follow-up
2019 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 37, no 1, p. 69-82Article in journal (Refereed) Published
Abstract [en]

Objective: Evaluate the feasibility of the COPD Web and its study design and study procedures and to increase the understanding of the potential effect of the tool in order to provide guidance for a future large scale trial.

Design: Parallel-group controlled pragmatic pilot trial.

Subjects: There was a total of 83 patients with COPD (mean age 70 +/- 8 years with a forced expiratory volume in first second percent predicted of 60 +/- 17%). The intervention group (n = 43) was introduced to and had access to the COPD Web in addition to usual care, while the control group (n = 40) received usual care alone.

Main outcome measures: The feasibility of the COPD Web (i.e., if and how the COPD Web was used) was automatically collected through the website, while outcomes on health, conceptual knowledge, and physical activity (PA) were collected through questionnaires at baseline, 3 months and 12 months.

Results: At 3 months, 77% of the intervention group was considered users, and the majority of time spent on the site was related to PA and exercises and was spent during the first month (>80%). In addition, the intervention group reported increased PA (odds ratio [OR] = 4.4, P < .001), increased conceptual knowledge in five domains (OR = 2.6-4.2, all P < .05), and altered disease management strategies (e.g., increased PA) (OR >= 2.7 P < .05) in comparison to the control group. The latter was also different between groups at 12 months (OR = 3.7, P = .044). Knowledge of PA was correlated with level of PA (rho = .425-.512, P < .05) as well as to the use of PA as a strategy to manage their disease (chi(2) = 11.2-32.9, P < .05).

Conclusion: Giving patients with COPD access to the COPD Web in addition to their ordinary primary care might be an effective shorter term (3 month) strategy to promote self-management. However, these results needs to be confirmed in a definitive large-scale trial.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
COPD, physical activity, self-management, pragmatic trial, internet-based
National Category
Physiology
Identifiers
urn:nbn:se:umu:diva-158765 (URN)10.1080/02813432.2019.1569415 (DOI)000462849900009 ()30700230 (PubMedID)
Available from: 2019-05-13 Created: 2019-05-13 Last updated: 2019-05-13Bibliographically approved
Lundell, S., Wadell, K., Wiklund, M. & Tistad, M. (2018). Interacting with primary care - experiences of patients with COPD. A qualitative study. Paper presented at 28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE. European Respiratory Journal, 52
Open this publication in new window or tab >>Interacting with primary care - experiences of patients with COPD. A qualitative study
2018 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Pulmonary rehabilitation aims to support self-management strategies and behaviour change in patients with COPD, which requires an interaction between the patients and healthcare professionals.

Aim: The aim was to explore how patients with COPD interact with primary care, and how they experience this interaction.

Methods: The study was conducted in primary care in northern Sweden. Interviews were performed with patients with COPD (n=13) with varied disease severity, symptoms, sex and age, from four primary care centres. The interviews were analysed with grounded theory.

Results: The analysis ended up in a process of becoming a more active patient with COPD, moving back and forth between different stages of interaction with primary care. The category building self-esteem with empowering support comprises factors that facilitated this process, such as having a positive spirit, experiences of availability, continuity and regular contacts in primary care, along with a good support where the patients felt respected.

The simultaneous and conflicting category struggling with the stigma and threat of COPD captures factors inhibiting the process such as the patients’ fear of dyspnea and death, along with feelings of shame and guilt, the low status of COPD and disempowering support from primary care.

Conclusions: The interaction with primary care could be seen as an ongoing, flexible empowering process for patients with COPD, affected by both inhibiting and facilitating factors. These results could help primary care to empower patients with COPD and facilitate their social process of becoming more active and in control of their disease by using the facilitating factors and decreasing the inhibiting factors.

Place, publisher, year, edition, pages
European Respiratory Society, 2018
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-155985 (URN)10.1183/13993003.congress-2018.PA1496 (DOI)000455567102050 ()
Conference
28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE
Note

Supplement: 62

Meeting Abstract: PA1496

Available from: 2019-02-07 Created: 2019-02-07 Last updated: 2019-02-07Bibliographically approved
Tistad, M., Flink, M., Ytterberg, C., Eriksson, G., Guidetti, S., Tham, K. & von Koch, L. (2018). Resource use of healthcare services 1 year after stroke: a secondary analysis of a cluster-randomised controlled trial of a client-centred activities of daily living intervention. BMJ Open, 8(8), Article ID e022222.
Open this publication in new window or tab >>Resource use of healthcare services 1 year after stroke: a secondary analysis of a cluster-randomised controlled trial of a client-centred activities of daily living intervention
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 8, article id e022222Article in journal (Refereed) Published
Abstract [en]

Objective The objective of the study was to compare the total use of healthcare services in the course of the first year after a stroke between participants who, after the acute care, had received occupational therapy as a client-centred activities of daily living (ADL) intervention (CADL) and participants who had received usual ADL intervention (UADL).

Design A secondary analysis of a multicentre cluster-randomised controlled trial (RCT).

Setting Primary and secondary care in Sweden.

Participants Participants were included if they: (1) had received CADL or UADL in the RCT, either as inpatients in geriatric rehabilitation units or in their own homes, and (2) data could be retrieved about their use of healthcare services provided by the county council from computerised registers.

Interventions CADL or UADL.

Outcome measures Inpatient and outpatient healthcare in the course of the first year after stroke.

Results Participants from 7 of the 16 units included in the RCT met the criteria. Participants in the CADL group (n=26) who received geriatric inpatient rehabilitation had a shorter length of hospital stay (p=0.03) than participants in the UADL group (n=46), and the CADL group with home rehabilitation (n=13) had fewer outpatient contacts (p=0.01) compared with the UADL group (n=25). Multiple regression analyses showed that in four of the models, a higher age was associated with a lower use of healthcare services. The use of healthcare services was also associated (some of the models) with dependence in ADL, stroke severity and type of rehabilitation received, CADL or UADL.

Conclusions The provision of client-centred occupational therapy after stroke did not appear to increase the use of healthcare services during the first year after stroke.

Trial registration number NCT01417585.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
Keywords
health care services, resource utilisation
National Category
Occupational Therapy
Identifiers
urn:nbn:se:umu:diva-152993 (URN)10.1136/bmjopen-2018-022222 (DOI)000446470200137 ()30082359 (PubMedID)
Funder
Stockholm County Council, 20080156Stockholm County Council, 20100107Swedish Research Council, 2010-2943
Available from: 2018-11-01 Created: 2018-11-01 Last updated: 2018-11-01Bibliographically approved
Tistad, M., Lundell, S., Wiklund, M., Nyberg, A., Holmner, Å. & Wadell, K. (2018). Usefulness and relevance of an eHealth Tool in supporting the self-management of chronic obstructive pulmonary disease: explorative qualitative study of a cocreative process. JMIR Human Factors, 5(4), Article ID e10801.
Open this publication in new window or tab >>Usefulness and relevance of an eHealth Tool in supporting the self-management of chronic obstructive pulmonary disease: explorative qualitative study of a cocreative process
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2018 (English)In: JMIR Human Factors, E-ISSN 2292-9495, Vol. 5, no 4, article id e10801Article in journal (Refereed) Published
Abstract [en]

Background: New strategies are urgently needed to support self-management for people with chronic obstructive pulmonary disease (COPD) in primary care. The use of electronic health (eHealth) solutions is promising. However, there is a lack of knowledge about how such eHealth tools should be designed in order to be perceived as relevant and useful and meet the needs and expectations of the health professionals as well as people with COPD and their relatives.

Objective: The objective of this study was to explore the aspects of an eHealth tool design and content that make it relevant and useful for supporting COPD-related self-management strategies from the perspective of health care professionals, people with COPD and their relatives, and external researchers.

Methods: Data were collected during the development of an eHealth tool. A cocreation process was carried out with participants from two primary care units in northern Sweden and external researchers. Individual interviews were performed with health care professionals (n=13) as well as people with COPD (n=6) and their relatives (n=2), and focus group discussions (n=9) were held with all groups of participants. Data were analyzed using qualitative content analysis.

Results: The overarching theme, reinforcing existing support structures, reflects participant views that the eHealth tool needs to be directly applicable and create a sense of commitment in users. Moreover, participants felt that the tool needs to fit with existing routines and contexts and preferably should not challenge existing hierarchies between health care professionals and people with COPD. Important content for health care professionals and people with COPD included knowledge about self-management strategies. Videos were regarded as the most effective method for communicating such knowledge.

Conclusions: The cocreation in the development process enables participant perspectives and priorities to be built into the eHealth tool. This is assumed to contribute to a tool that is useful and relevant and, therefore, adopted into clinical practice and everyday life. Findings from this study can inform the development of eHealth tools for people with COPD in other contexts, as well as the development of eHealth tools for self-management support of other chronic diseases.

Keywords
COPD, eHealth, cocreation, self-management, primary care, chronic disease, user involvement, KOL, eHälsa, egenvård, primärvård, kroniska sjukdomar, samskapande, användarsamverkan
National Category
Physiotherapy
Research subject
Physiotherapy; Lung Medicine
Identifiers
urn:nbn:se:umu:diva-152605 (URN)10.2196/10801 (DOI)30368440 (PubMedID)
Funder
Swedish Research Council, K2014-99X-22572-01-4Swedish Heart Lung Foundation, 20130331
Available from: 2018-10-15 Created: 2018-10-15 Last updated: 2018-11-09Bibliographically approved
Lundell, S., Tistad, M., Rehn, B., Wiklund, M., Holmner, Å. & Wadell, K. (2017). Building COPD care on shaky ground: a mixed methods study from Swedish primary care professional perspective. BMC Health Services Research, 17, Article ID 467.
Open this publication in new window or tab >>Building COPD care on shaky ground: a mixed methods study from Swedish primary care professional perspective
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2017 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, article id 467Article in journal (Refereed) Published
Abstract [en]

Background: Chronic obstructive pulmonary disease (COPD) is a public health problem. Interprofessional collaboration and health promotion interventions such as exercise training, education, and behaviour change are cost effective, have a good effect on health status, and are recommended in COPD treatment guidelines. There is a gap between the guidelines and the healthcare available to people with COPD. The aim of this study was to increase the understanding of what shapes the provision of primary care services to people with COPD and what healthcare is offered to them from the perspective of healthcare professionals and managers.

Methods: The study was conducted in primary care in a Swedish county council during January to June 2015. A qualitatively driven mixed methods design was applied. Qualitative and quantitative findings were merged into a joint analysis. Interviews for the qualitative component were performed with healthcare professionals (n = 14) from two primary care centres and analysed with qualitative content analysis. Two questionnaires were used for the quantitative component; one was answered by senior managers or COPD nurses at primary care centres (n = 26) in the county council and the other was answered by healthcare professionals (n = 18) at two primary care centres. The questionnaire data were analysed with descriptive statistics.

Results: The analysis gave rise to the overarching theme building COPD care on shaky ground. This represents professionals driven to build a supportive COPD care on 'shaky' organisational ground in a fragmented and non-compliant healthcare organisation. The shaky ground is further represented by uninformed patients with a complex disease, which is surrounded with shame. The professionals are autonomous and pragmatic, used to taking responsibility for their work, and with limited involvement of the management. They wish to provide high quality COPD care with interprofessional collaboration, but they lack competence and are hindered by inadequate routines and lack of resources.

Conclusions: There is a gap between COPD treatment guidelines and the healthcare that is provided in primary care. To facilitate implementation of the guidelines several actions are needed, such as further training for professionals, additional resources, and improved organisational structure for interprofessional collaboration and patient education.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Chronic obstructive pulmonary disease, Primary care, Healthcare professionals, Mixed methods, Healthcare system, Organisation, Implementation, Health promotion, Treatment guidelines, Sweden
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-137946 (URN)10.1186/s12913-017-2393-y (DOI)000405243000001 ()
Available from: 2017-08-02 Created: 2017-08-02 Last updated: 2018-10-17Bibliographically approved
Nyberg, A., Wadell, K., Lindgren, H. & Tistad, M. (2017). Internet-based support for self-management strategies for people with COPD-protocol for a controlled pragmatic pilot trial of effectiveness and a process evaluation in primary healthcare. BMJ Open, 7(7), Article ID e016851.
Open this publication in new window or tab >>Internet-based support for self-management strategies for people with COPD-protocol for a controlled pragmatic pilot trial of effectiveness and a process evaluation in primary healthcare
2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 7, article id e016851Article in journal (Refereed) Published
Abstract [en]

Introduction: The use of adequate self-management strategies for people with chronic obstructive pulmonary disease (COPD) reduces healthcare use, improves health-related quality of life (HRQoL) and recovery after acute exacerbations. However, not many people with COPD receive support that promotes the use of such strategies and therefore new methods to facilitate and promote the use of self-management strategies are highly warranted. This pilot trial aims to evaluate the feasibility of the study design and study procedures considering effectiveness of the novel intervention, the COPD-web.

Methods and analysis: The overall design is a pragmatic controlled pilot trial with preassessments and postassessments and a parallel process evaluation. Patients with the diagnosis of COPD will be eligible for the study. The intervention group will be recruited when visiting one of the six participating primary care units in Sweden. The control group will be identified from the unit's computerised registers. The intervention, the COPD-web, is an interactive web page with two sections; one directed at people with COPD and one at healthcare professionals. The sections aim to support patients' self-management skills—and to facilitate the provision of support for self-management strategies, respectively. Effectiveness with regard to patients' symptoms, HRQoL, knowledge of and readiness for COPD-related self-management, health literacy, self-efficacy for physical activity and time spent in physical activity and time being sedentary, and further, healthcare professionals' knowledge of and readiness to support COPD-related self-management strategies will be assessed using questionnaires at 3 and 12 months. The process evaluation will include observations and interviews.

Ethics and dissemination: Ethical approval has been obtained. Findings will be presented at conferences, submitted for publication in peer-reviewed publications and presented to the involved healthcare professionals, patients and to patient organisations.

Trial registration number: ClinicalTrials.gov: NCT02696187

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2017
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-139054 (URN)10.1136/bmjopen-2017-016851 (DOI)000410203700207 ()28765136 (PubMedID)
Available from: 2017-09-06 Created: 2017-09-06 Last updated: 2018-06-09Bibliographically approved
Tistad, M., Palmcrantz, S., Wallin, L., Ehrenberg, A., Olsson, C. B., Tomson, G., . . . Eldh, A. C. (2016). Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness. International Journal of Health Policy and Management, 5(8), 477-486
Open this publication in new window or tab >>Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness
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2016 (English)In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 5, no 8, p. 477-486Article in journal (Refereed) Published
Abstract [en]

Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers' leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention's potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers' behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations.

Keywords
Evidence-Based Practice (EBP), Facilitation, Implementation, Leadership, Management, Stroke Rehabilitation
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-124499 (URN)10.15171/ijhpm.2016.35 (DOI)000379825600005 ()
Available from: 2016-08-22 Created: 2016-08-15 Last updated: 2018-06-07Bibliographically approved
Nyberg, A., Tistad, M. & Wadell, K. An internet based tool to promote self-management in patients with COPD in primary care: a controlled pragmatic pilot trial with short- and long-term follow-up. Scandinavian Journal of Primary Health Care
Open this publication in new window or tab >>An internet based tool to promote self-management in patients with COPD in primary care: a controlled pragmatic pilot trial with short- and long-term follow-up
(Swedish)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724Article in journal (Refereed) Accepted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-154258 (URN)
Available from: 2018-12-14 Created: 2018-12-14 Last updated: 2018-12-18
Lundell, S., Wadell, K., Wiklund, M. & Tistad, M.Enhancing confidence or coping with stigma in an ambiguous interaction with primary care: a qualitative study of people with COPD.
Open this publication in new window or tab >>Enhancing confidence or coping with stigma in an ambiguous interaction with primary care: a qualitative study of people with COPD
(English)Manuscript (preprint) (Other academic)
Keywords
Empowerment, self-management, healthcare professionals, grounded theory, ambiguity, COPD, primary care
National Category
Physiotherapy
Research subject
Physiotherapy; Lung Medicine
Identifiers
urn:nbn:se:umu:diva-152608 (URN)
Available from: 2018-10-15 Created: 2018-10-15 Last updated: 2018-10-15
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